State of the Art: Response Assessment in Lung Cancer in the Era of Genomic Medicine

Effective targeted therapies for specific genomic abnormalities in lung cancer and their clinical application have brought revolutionary advances in therapy and transformed the oncologist’s approach to the disease. Because imaging is a major method of response assessment in lung cancer in clinical trials and practice, radiologists must understand the genomic alterations in lung cancer and the rapidly evolving therapeutic approaches to effectively communicate with oncology colleagues and maintain a key role in lung cancer care.

In a State-of-the-Art article in the April issue of Radiology (RSNA.org/Radiology), Mizuki Nishino, M.D., of the Dana-Farber Cancer Institute, Boston, and colleagues present recent genomic discoveries in lung cancer and therapies directed against these genomic changes and describe how these discoveries affect radiology. The authors also summarize the conventional Response Evaluation Criteria in Solid Tumors and World Health Organization guidelines and describe their limitations, particularly in an era of genomic-based therapy.

Advanced imaging techniques using multidetector CT, MR imaging and PET are also discussed by the authors. “Imaging is the major tool in response assessment of lung cancer,” the authors write. “Knowledge of the recent discoveries of genomic mechanisms of lung cancer and their clinical applications in molecular targeting therapy is essential for radiologists to interpret imaging studies and assess response in lung cancer patients receiving molecular targeting therapy.”

This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available online only.

Digital Breast Tomosynthesis in the Analysis of Fat-containing Lesions

While digital breast tomosynthesis (DBT) is rapidly emerging as an important screening and diagnostic tool in the clinical setting, the subtleties of interpretation with this modality are new to all radiologists.

Many masses, both benign and malignant, may contain fat, which manifests as radiolucencies that are visible at DBT. If fat seen in breast masses at DBT is not appropriately analyzed, malignant breast masses may be incorrectly classified as probably or even definitely benign, according to an article in the March-April issue of RadioGraphics (RSNA.org/RadioGraphics).

Phoebe E. Freer, M.D., of Massachusetts General Hospital, Boston, and colleagues discuss the use of DBT in the evaluation of various encapsulated fat-containing lesions (lipomas, hamartomas, galactoceles and lipid cysts) and nonencapsulated fat-containing lesions (nonencapsulated lobulated masses and especially spiculated fat-containing masses). Using radiologic-pathologic correlation, the authors illustrate cases in which the presence of fat can help correctly classify a mass as benign and pitfalls in which the presence or absence of fat within a mass is irrelevant and should not influence analysis.

Recognizing that existing fat within the breast can be engulfed by an evolving malignant process is critical, according to the authors. “Therefore, the radiologist should be judicious when referencing the presence or absence of fat on a DBT image and should remember that, whereas most encapsulated fat-containing masses may be confidently classified as benign, nonencapsulated fat-containing masses should be considered suspicious until proved otherwise,” the authors write.

This article meets the criteria for AMA PRA Category 1 Credit™. SA-CME is available in print.

RadioGraphics CME Tests Now Online Only

RadioGraphics readers may notice the absence of CME tests and answer postcards from future print editions of the journal: All CME tests are now published in an interactive online format with immediate return of the test-taker’s score and credit earned upon completion.

The tests can be accessed from the online journal pages by clicking “CME” or “SA-CME TEST”; from the article page in the RadioGraphics mobile app by tapping on the bulleted list symbol and choosing, “Take SA-CME” from the drop-down menu; or directly via the Internet by typing RSNA.org/education/search/RG into the browser window.

In the May-June issue, users of the online tests will be able to print a complete list of questions before taking a test. An after-test survey provides space for feedback and topic suggestions for future CME activities.

RadioGraphics Editor Jeffrey S. Klein discusses his decision to “Go Green with CME” in his editorial in the March-April issue at RSNA.org/RadioGraphics.

Online RadioGraphics’ Tutorials Target Trainees

A new series of online presentations targeting radiology trainees will debut in RadioGraphics this spring in the journal’s new Resident and Fellow Education section.

The March-April issue features a tutorial on cystic lesions of the female lower genitourinary tract by Marc Tubay, M.D., and colleagues, while the May-June issue will feature a tutorial on diagnostic imaging of various types of bladder injury by Jordan S. Gross, M.D. A similar presentation on imaging of the peritoneum is planned for the July-August issue.

Each of these online features offers a concise explanation of key concepts that correspond to well-defined learning objectives; is fully illustrated with radiologic images, anatomic drawings, diagrams and other learning aids; is viewable in 30 minutes or less; and includes a list of suggested readings for readers who want to delve further into the topic. A two-page abstract published in tandem with each presentation provides an overview of the contents, allowing readers to quickly judge its applicability for their learning needs.

The presentations originated as RSNA Annual Meeting education exhibits and were selected specifically for radiology trainees by Resident and Fellow Education section chair Jennifer A. Harvey, M.D., and assistant chair Sanjeev Bhalla, M.D., with input from the RadioGraphics subspecialty reviewers and Editor Jeffrey S. Klein, M.D. The presentations undergo rigorous independent peer review, revision by the authors, copyediting by RSNA editorial staff and vetting by radiology educators for level of difficulty/appropriateness for residents and fellows; not all of those selected are accepted for publication in RadioGraphics.